Cluster headache is recognized by the medical community as one of the most severe and excruciating primary headache disorders. Its intensity is so profound that patients have been known to resort to extreme measures to alleviate the pain, often surpassing the agony of childbirth or cancer.
Due to its predictable, cyclical nature, patients have colloquially termed it the“alarm clock headache.” Historically, misdiagnosis and ineffective treatments led to the unfortunate moniker “suicide headache.”
At Peking University International Hospital, the Neurosurgery Department offers a minimally invasive interventional treatment system centered on sphenopalatine ganglion block. This precision pain-relief approach provides a new lifeline for patients with stubborn headaches, aiming to “turn off the pain switch and end the cycle of recurring nightmares” when conventional medications fail or cause intolerable side effects.
What is the Sphenopalatine Ganglion (SPG)? The “Headache Switch” Hidden in Your Face
The sphenopalatine ganglion (SPG), also known as the pterygopalatine ganglion, is the largest parasympathetic nerve cluster in the human head. It is situated deep within the face, within the pterygopalatine fossa—a small, inverted-pyramid-shaped space located behind the nasal cavity and posterior to the upper jawbone, in close proximity to numerous vital blood vessels and nerves.
Functioning as a sophisticated “neural relay station,” it receives sensory input from the maxillary branch of the trigeminal nerve, parasympathetic fibers from the facial nerve, and sympathetic fibers from the superior cervical ganglion. It then dispatches multiple branches that regulate lacrimal gland secretion, vasoconstriction and glandular secretion in the nasal mucosa, among other functions.
When the SPG becomes abnormally activated, it triggers a trigeminal-autonomic reflex. This leads to the release of neurotransmitters such as vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP), causing cerebral blood vessel dilation and neurogenic inflammation. This cascade of events ignites a cluster headache attack, often accompanied by characteristic autonomic symptoms on the same side of the face, including tearing, conjunctival injection (red eyes), and nasal congestion or rhinorrhea (runny nose).
Consequently, the sphenopalatine ganglion (SPG) is often referred to as the“headache switch,” as precise intervention at this point can effectively shut off the source of pain.”
What is a SPG Block? “Pulling the Circuit Breaker” on Nerve Pain
A sphenopalatine ganglion block (SPG Block for short), as its name implies, involves the precise injection of a local anesthetic (such as lidocaine) near the sphenopalatine ganglion. This temporarily “numbs” or“calms” the overexcited nerve cluster, rapidly blocking the transmission of abnormal pain signals and interrupting the autonomic reflex that contributes to headache attacks.
This procedure can be likened to addressing an overheating electrical system: instead of extinguishing a widespread fire, the intervention precisely targets and “flips the switch” on the specific malfunctioning circuit.
It selectively blocks abnormal nerve signals without affecting normal brain function. This technique serves a dual purpose: it is a valuable diagnostic tool for confirming whether pain originates from the sphenopalatine ganglion (diagnostic block) and a rapid therapeutic intervention for conditions like cluster headaches (therapeutic block).
Precision Puncture: C-arm Guided “Visualized” Targeted Therapy
At Peking University International Hospital, the Neurosurgery Department utilizes a state-of-the art hybrid operating room equipped with real-time C-arm fluoroscopy. Unlike a single image produced by x-ray, under fluoroscopy, continuous, real-time images are produced.
This advanced imaging guidance allows for the precise advancement of a hair-thin needle to the sphenopalatine ganglion target within the pterygopalatine fossa, carefully avoiding blood vessels, nerves, and vital organs. The entire procedure typically takes only 10 to 15 minutes, representing a truly minimally invasive treatment with an entry point no larger than a pinprick, ensuring exceptionally high safety.
Significant Advantages: Immediate Pain Relief + Long-lasting Protection
- Rapid Onset, Instant Pain Relief: For acute cluster headache attacks, a sphenopalatine ganglion block can typically halt pain within minutes, earning it the reputation of a “lifeline.” Studies indicate that patients undergoing this treatment often experience a significant reduction in pain scores, dropping from a severe 5–7 (on a 0–10 scale) pre-procedure to a mild 1–2 (slight discomfort) immediately afterward.
- Long-lasting Protection, Reduced Attacks: A single treatment often provides symptom relief lasting several weeks to months, enabling most patients to navigate an entire cluster period with significantly reduced pain. For individuals experiencing chronic episodes, the block can be safely repeated if symptoms recur.
- Precise, Minimally Invasive, and Safe: Real-time imaging guidance ensures accurate targeting, making complications exceedingly rare. The procedure requires no surgical incision and leaves no scars, allowing patients to resume normal activities almost immediately post-procedure.
- Reduced Medication Dependence: This treatment offers a valuable alternative for patients who prefer to avoid long-term oral medications, experience adverse drug side effects, or have developed resistance to standard pharmacological therapies.
Indications: Who Can Benefit?
While cluster headache is the most prominent and responsive indication for sphenopalatine ganglion block, it is also widely utilized as an adjunctive treatment for a range of other conditions, including:
- Migraine (particularly when accompanied by autonomic symptoms such as tearing or nasal congestion)
- Chronic or allergic rhinitis, and vasomotor rhinitis
- Trigeminal neuralgia and atypical facial pain
- Atypical facial pain syndromes (e.g., nasociliary neuralgia)
- Post-herpetic neuralgia affecting the head and face
- Post-dural-puncture headache (PDPH)
Patient Case Study:
A 43-year-old male patient presented with a history of intermittent, excruciating pain in his right forehead, accompanied by nasal congestion and rhinorrhea, spanning eight years. Initially, he experienced approximately one attack per year. However, over the past year, the frequency dramatically increased to 4–5 episodes annually. Each cluster period typically lasted two weeks, with attacks predominantly occurring during the daytime — and often with precise timing, such as commencing sharply at 9 a.m.
The pain was described as paroxysmal and knife-like, lasting for several hours. During these episodes, the patient exhibited extreme agitation, even resorting to banging his head against the wall. Despite seeking treatment at numerous hospitals across the country, he had not achieved satisfactory relief.
Intraoperative Image
Diagnosis and Treatment: Following a comprehensive systemic evaluation by the Neurosurgery Department at Peking University International Hospital, he was diagnosed with chronic cluster headache. Under precise image guidance, he underwent a pulsed radiofrequency procedure combined with a sphenopalatine ganglion block. This targeted treatment was delivered via a trans-pterygopalatine-fossa approach after local anesthesia.
Outcome: Post-procedure, the patient experienced significant pain relief. The debilitating, unbearable agony did not return, and his quality of life was fully restored.
For anyone suffering from debilitating headaches, this minimally invasive approach offers new hope — turning off the “headache switch” and letting patients reclaim their lives.
Department Introduction
Established in October 2015 in collaboration with Beijing Tiantan Hospital, Capital Medical University, the Department of Neurosurgery at Peking University International Hospital has evolved into a major neurosurgical center in northern Beijing. Under the leadership of Professor Zhao Yuanli’s team from Beijing Tiantan Hospital between 2015 and 2022, the department has consistently adhered to the principles of "minimally invasive surgery" and "precision medicine," while maintaining a patient-centered care model.
The Department of Neurosurgery has become a leading center that integrates clinical care, education, and research. In 2021, the department was officially designated as a National Center for Neurointerventional Capacity Building and Continuing Education by the National Health Commission. It has also gained national recognition, being nominated in the discipline of Neurosurgery by the Fudan University Hospital Ranking.
The department currently operates two inpatient zones with a total of 69 beds. It primarily manages patients with cerebrovascular diseases, intracranial and spinal tumors, spinal cord disorders, traumatic brain injuries, congenital neural malformations, hydrocephalus, and functional neurosurgical conditions—including epilepsy, disorders of consciousness, trigeminal neuralgia, and hemifacial spasm.
The department is fully equipped with state-of-the-art neurosurgical technologies, including a hybrid operating room, high-field intraoperative MRI composite operating suite, neuronavigation systems, stereotactic biopsy equipment, neuroendoscopy, intraoperative neurophysiological monitoring, intraoperative ultrasound, and neurosurgical robotics.
Nursing practices within the department follow international standards and incorporate the concept of early rehabilitation. Strategies such as minimizing preoperative fasting periods, encouraging early postoperative mobilization, and localized skin preparation are utilized to reduce surgical stress, prevent complications, and expedite recovery of organ function—ultimately supporting the patient’s physical and psychological healing.
Dr. NIU Hongchuan
Associate Chief Doctor
Professional Summary
Preoperative evaluation for epilepsy, consciousness disorders and related research in functional neurosurgery. Skilled in stereotactic brain lesion biopsy, stereotactic-guided deep brain electrode implantation, spinal cord stimulation, and microvascular decompression for hemifacial spasm, trigeminal neuralgia, etc.
Resume
Specializes in the surgical treatment of epilepsy (FCD, cavernous hemangioma, low-grade gliomas, tuberous sclerosis, etc.). Magnetic resonance-guided laser-induced thermal ablation (LITT) for intracranial lesions.
Preoperative evaluation and functional neurosurgical treatment for coma, vegetative state, and impaired consciousness. Microvascular decompression for various pain conditions, such as facial spasm and trigeminal neuralgia, as well as minimally invasive treatments for trigeminal neuralgia.
Neurostimulation therapy for hemiplegia following cerebral infarction, dystonia following brain and spinal cord injuries, postural hypotension associated with spinal cord injury, and treatment-resistant depression. Brain-computer interface (BCI) modulation therapy.
Academic and Professional Positions
- Director, Branch of Comprehensive Neurostimulation Management, China Health Management Association
- Member, Expert Committee on Neurostimulation and Human-Machine Interaction, Beijing Medical Association
